Trigeminal Neuralgia

What is Trigeminal Neuralgia?

Tic Douloureux or Trigeminal Neuralgia (TN) is a neuropathic disorder causing episodes of intense pain in the eyes, lips, nose, scalp, forehead and jaw. The condition of TN is typically characterized by sudden and brief attacks of intense and stabbing pain and is usually limited to one side of the face.

The incidence of trigeminal neuralgia is relatively low with a rate of 150 per million people per year. It usually develops after the age of 40. Incidence of trigeminal neuralgia has been found to be quite higher in women as compared to men.

The various types of trigeminal neuralgia include:

1. Typical Trigeminal Neuralgia

2. Atypical trigeminal Neuralgia

3. Pre-Trigeminal Neuralgia

4. Multiple Sclerosis-related Trigeminal Neuralgia

5. Secondary or Tumor related Trigeminal Neuralgia

6. Post traumatic trigeminal Neuralgia

7. ‘Failed’ trigeminal Neuralgia

Causative Factors

The onset of trigeminal neuralgia is assumed to be a blood vessel pressing on the trigeminal nerve in the head, which sends branches to the forehead, cheek and lower jaw.

Other causes of trigeminal neuralgia include pressure of a tumor on the nerve or multiple sclerosis, damaging the myelin sheaths.

Besides, attacks of trigeminal neuralgia may be triggered of by the one of the below:

• Light touch on the skin

• Washing

• Shaving, brushing the teeth

• Blowing the nose

• Drinking hot or cold beverages

• Encountering a light breeze

• Applying makeup

• Smiling and talking

Diagnosis and Treatment

Trigeminal neuralgia is usually diagnosed based on the description of the symptoms given by the patient.

The line of treatment for Trigeminal Neuralgia includes two basic options of medications and surgery. Here we list the main amongst the both.

A) Medications

i) Phenytoin, an anticonvulsant and the first drug that was used to treat trigeminal neuralgia.

ii) Carbamazepine, also an anticonvulsant and one of the most common medications prescribed for trigeminal neuralgia.

iii) Baclofen, a muscle relaxant, should be used in combination with either of the two above for best results.

iv) Oxcarbazepine, a comparatively newer medicine and is regarded as having minimum side effects.

Other medicines include pregabalin, gabapentin, clonazepam, sodium valporate, lamotrigine and topiramate.

B) Surgical Options

Most of the surgical options have a varying success rate and accompanying side effects such as recurrence of pain and facial numbness. Most common forms of surgery required for trigeminal neuralgia include:

i) Microvascular decompression

ii) Percutaneous glycerol rhizotomy

iii) Percutaneous balloon compression

iv) Stereotactic radiosurgery

v) Motor cortex stimulation

In fact, trigeminal neuralgia is often referred to as the ‘suicide disease’. The reason for this being the significant number of people taking their own lives; unable to bear the pain and not healed adequately by medications or surgery.